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Form 1099-SA | Health Savings Account | Fidelity

Fidelity INVESTMENTS.. Your Form 1099-SA . for Your Health Savings Account (HSA). You may receive more than one Form 1099-SA , because distribution information on each form is limited to one Account and one distribution code. 2021 Form 1099-SA Distributions from an HSA. National Financial Services LLC 123-456789 **-**-0000 1 of 2. Distributions from your Fidelity HSA will be reported Agent for Fidelity Personal Trust Company Box 28019. Albuquerque, NM 87125-8019 by Fidelity to you and the IRS each tax year on IRS. Envelope 0000000000. Federal ID Number: 00-0000000.

1099-SA, 5498-SA, IRS Publication 969, “Health Savings Accounts and Other Tax-Favored Health Plans,” and IRS Publication 502, “Medical and Dental Expenses.” Title

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